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EP1883440B1 - Appareil d'assistance respiratoire - Google Patents

Appareil d'assistance respiratoire Download PDF

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Publication number
EP1883440B1
EP1883440B1 EP06747709.1A EP06747709A EP1883440B1 EP 1883440 B1 EP1883440 B1 EP 1883440B1 EP 06747709 A EP06747709 A EP 06747709A EP 1883440 B1 EP1883440 B1 EP 1883440B1
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EP
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Prior art keywords
gases
temperature
patient
heater
temperature sensor
Prior art date
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Application number
EP06747709.1A
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German (de)
English (en)
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EP1883440A1 (fr
EP1883440A4 (fr
Inventor
Matthew Jon Payton
Kevin Peter O'donnell
Christopher Simon James Quill
Ian Douglas Makinson
Emily Joy Drake
Virginia Louise Glover
Craig Karl White
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Fisher and Paykel Healthcare Ltd
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Fisher and Paykel Healthcare Ltd
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Publication of EP1883440A4 publication Critical patent/EP1883440A4/fr
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/06—Respiratory or anaesthetic masks
    • A61M16/0666—Nasal cannulas or tubing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/10—Preparation of respiratory gases or vapours
    • A61M16/14—Preparation of respiratory gases or vapours by mixing different fluids, one of them being in a liquid phase
    • A61M16/16—Devices to humidify the respiration air
    • A61M16/161—Devices to humidify the respiration air with means for measuring the humidity
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M16/0006—Accessories therefor, e.g. sensors, vibrators, negative pressure with means for creating vibrations in patients' airways
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/0057—Pumps therefor
    • A61M16/0066—Blowers or centrifugal pumps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/0057—Pumps therefor
    • A61M16/0066—Blowers or centrifugal pumps
    • A61M16/0069—Blowers or centrifugal pumps the speed thereof being controlled by respiratory parameters, e.g. by inhalation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/0087—Environmental safety or protection means, e.g. preventing explosion
    • A61M16/009—Removing used or expired gases or anaesthetic vapours
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/021—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes operated by electrical means
    • A61M16/022—Control means therefor
    • A61M16/024—Control means therefor including calculation means, e.g. using a processor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/08—Bellows; Connecting tubes ; Water traps; Patient circuits
    • A61M16/0875—Connecting tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/10—Preparation of respiratory gases or vapours
    • A61M16/1075—Preparation of respiratory gases or vapours by influencing the temperature
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/10—Preparation of respiratory gases or vapours
    • A61M16/1075—Preparation of respiratory gases or vapours by influencing the temperature
    • A61M16/109—Preparation of respiratory gases or vapours by influencing the temperature the humidifying liquid or the beneficial agent
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/10—Preparation of respiratory gases or vapours
    • A61M16/1075—Preparation of respiratory gases or vapours by influencing the temperature
    • A61M16/1095—Preparation of respiratory gases or vapours by influencing the temperature in the connecting tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/10—Preparation of respiratory gases or vapours
    • A61M16/14—Preparation of respiratory gases or vapours by mixing different fluids, one of them being in a liquid phase
    • A61M16/16—Devices to humidify the respiration air
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/06—Respiratory or anaesthetic masks
    • A61M16/0683—Holding devices therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/003—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3303—Using a biosensor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3368—Temperature
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/36—General characteristics of the apparatus related to heating or cooling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/50—General characteristics of the apparatus with microprocessors or computers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2230/00—Measuring parameters of the user
    • A61M2230/40—Respiratory characteristics

Definitions

  • This invention relates to a breathing gases supply and gases humidification apparatus and a method of controlling such apparatus.
  • Uses for the breathing assistance apparatus of the present invention are the supply of gases for any medical condition or treatment that results in the drying of the upper airways, and/or salivary glands, such as head or neck radiotherapy or long term oxygen therapy. Further uses are for medical conditions that result in impaired mucociliary clearance systems such as Chronic Obstructive Pulmonary Disease (COPD) or bronchiectasis or in the supply of Continuous Positive Airway Pressure (CPAP) to treat Obstructive Sleep Apnoea (OSA) or other respiratory conditions.
  • COPD Chronic Obstructive Pulmonary Disease
  • CPAP Continuous Positive Airway Pressure
  • GB2338420 discloses a warm up mode for a CPAP device, where because water vapour generated by the humidifier at start up is very low, the pressure of the gases are controlled so that the required pressure and resulting flow rate is reached at the same time as the required humidity level is reached. It discloses incremental adjustments of pressure to keep pace with the increases in humidity.
  • WO02/32486 discloses a combination insufflator and humidifier that supplies gases to a patient, particularly one undergoing laparoscopic surgery.
  • US4955372 discloses an apparatus for delivering a humidified stream of gas to an animal's respiratory tract, for conditioning the respiratory pulmonary and/or cardiovascular system in an animal.
  • Continuous Positive Airway Pressure involves the administration of air under pressure to a patient, usually by a nasal mask. It is used in the treatment of snoring and Obstructive Sleep Apnoea (OSA), a condition characterised by repetitive collapse of the upper airway during inspiration. Positive pressure splints the upper airway open, preventing its collapse.
  • OSA Obstructive Sleep Apnoea
  • Treatment of OSA with nasal CPAP has proven to be both effective and safe, but CPAP is difficult to use and the majority of patients experience significant side effects, particularly in the early stages of treatment.
  • CPAP is also commonly used for patients with a variety of respiratory illnesses, including COPD.
  • Upper airway symptoms adversely affect treatment with CPAP. Mucosal drying is uncomfortable and may awaken patients during the night. Rebound nasal congestion commonly occurs during the following day, simulating a viral infection. If untreated, upper airway symptoms adversely affect rates of CPAP use. Increases in nasal resistance may affect the level of CPAP treatment delivered to the pharynx, and reduce the effectiveness of treatment. An individual pressure is determined for each patient using CPAP and this pressure is set at the patient interface. Changes in nasal resistance affect pressure delivered to the pharynx and if the changes are of sufficient magnitude there may be recurrence of snoring or airway collapse or reduce the level of pressure applied to the lungs. Such symptoms can also occur in a hospital environment where a patient is on a respirator. Typically in such situations the patient is intubated. Therefore the throat tissue may become irritated and inflamed causing both distress to the patient and possible further respiratory problems.
  • a number of methods may be employed to treat such upper airway symptoms, including pharmacological agents to reduce nasal disease, or heating the bedroom.
  • One most commonly employed method is humidification of the inspired air using an in line humidifier.
  • Two types of humidifier are currently used.
  • Cold pass-over humidifiers rely on humidifying the air through exposure to a large surface area of water. While they are cheap, the humidity output is low at high flows, typically 2 to 4 mg ⁇ L absolute humidity at flows above 25L/min. The output is insufficient to prevent mucosal drying.
  • Heated water bath humidifiers are more efficient, and produce high levels of humidity even at high flow rates. They are effective at preventing upper airway mucosal drying, prevent increases in nasal resistance, and are the most reliable means of treating upper airway symptoms.
  • Oxygen is the most common drug prescribed to hospitalized patients.
  • the delivery of oxygen via nasal cannula or facemask is of benefit to a patient complaining of breathlessness.
  • oxygen therapy reduces the effort to breathe and can correct resulting hypoxia (a low level of oxygen in the tissues).
  • the duration of the therapy depends on the underlying illness. For example, postoperative patients may only receive oxygen while recovering from surgery while patients with COPD require oxygen 16 to 18 hours per day.
  • Oxygen therapy provides enormous benefit to patients with an acute exacerbation of COPD who are hypoxic, by decreasing the risk of vital organ failure and reducing dyspnea.
  • the major complication associated with oxygen therapy is hypercarpnia (an elevation in blood carbon dioxide levels) and subsequent respiratory failure. Therefore, the dose of oxygen administered can be critical and must be precisely known.
  • the oxygen-enriched gas must exceed the patient's peak inspiratory flow to prevent the entrainment of room air and dilution of the oxygen.
  • flows of greater than 20 L/min are common. Such flows of dry gases cause dehydration and inflammation of the nasal passages and airways if delivered by nasal cannula.
  • a heated humidifier is used.
  • Interfaces include face masks, oral mouthpieces, tracheostomy inlets and nasal cannula, the latter having the advantage of being more comfortable and acceptable than a facemask.
  • the gases supply It is usual for the gases supply to provide a constant, prescribed level of gases flow to the humidifier.
  • the humidifier and conduit can then heat and humidify the gases to a set temperature and humidity before delivery to the patient. It is important to note that the warm-up time required from start-up for the gases to reach optimal temperature and humidity increases with higher flow rates.
  • the operating instructions of such a system commonly instruct the user not to connect the system to the patient until the humidifier has completed the warm-up period. Thereafter, patients receive up to 40L/min of near body temperature saturated gases. Patients often feel overwhelmed by sudden delivery of high flow at this time.
  • a group of patients who would benefit from humidification therapy are patients who have mucociliary clearance deficiencies. These patients often have purulent mucus and are susceptible to infections from pathogens. Heated humidified air with an abundance of water particles is an ideal medium to harbour disease carrying pathogens. Consequently, considerable design expertise has been required to provide the market with active pass-over humidifiers that deliver water molecules, in gas phase only, so that it is not possible for disease pathogens to be carried in air to the patient. Water that condenses on the inner surfaces of the breathing circuit or conduit at the end of a treatment session may harbour pathogens that would be delivered to the patient next time they use the device. This is particularly the case with therapies for COPD patients that are receiving body temperature fully saturated air.
  • the hygiene of a breathing circuit is particularly important when the humidification therapy is used for the treatment of respiratory diseases.
  • Any moisture remaining in the breathing circuit at the end of a treatment may harbour pathogens exhaled or expelled (as mucus may be expelled into the circuit or patient interface) by the patient.
  • This moisture provides a means to transport the pathogens in the tubing providing a source of further infection for the patient when the tubing is next used.
  • the tubing is not cleaned daily and therefore must be thoroughly dried at the end of treatment. This cleaning is time consuming and will not always be carried out to precise instructions.
  • the present invention consists in a breathing assistance apparatus adapted to deliver humidified gases at a desired level of humidity, flow and temperature for treatment of a patient comprising:
  • said apparatus further comprises:
  • said apparatus further comprises:
  • said transportation pathway means is an extruded plastic tube, and said pathway heater is at least two conductive wires embedded within, throughout or about the wall of said tube.
  • said controller includes stored instructions to determine said end of said treatment when said patient activates an "off" button connected to said controller.
  • said apparatus further comprises a patient interface sensor, and said controller includes stored instructions to determine said end of said treatment when said patient interface sensor detects that said patient has removed said patient interface for a predetermined period of time.
  • said controller includes stored instructions to determine said end of treatment when a substantial increase of flow of gases is detected exiting said gas supply means for a predetermined period of time.
  • said apparatus further comprises a patient interface sensor, and said controller includes stored instructions to determine said end of treatment when said patient interface sensor senses that said patient's breathing through said patient interface has ceased for a predetermined period of time.
  • the present invention consists in a method of controlling a breathing assistance apparatus where said apparatus is adapted to deliver humidified gases at a desired level of humidity, flow and temperature for treatment of a patient, said apparatus comprising a gases supply means providing a flow of gases, a humidifier having a chamber adapted to receive a volume of water and a chamber heater to heat said water in said chamber, transportation pathway means to convey said humidified gases from said humidifier to said patient, said transportation pathway means (3) comprising a pathway heater, and a controller that stores a program which causes the controller at the end of said treatment of said patient to:
  • said apparatus further comprises an outlet temperature sensor measuring the temperature of said gases at said outlet to said chamber, a distal temperature sensor measuring the temperature of said gases at the distal end of the transportation pathway means, an ambient temperature sensor measuring ambient air temperature, and said program further causes said controller to:
  • said apparatus further comprises a distal temperature sensor measuring the temperature of said gases at the distal end of the transportation pathway means, an ambient temperature sensor measuring ambient air temperature, a chamber heater temperature sensor measuring said chamber heater temperature, and said program further causes said controller to:
  • said program further causes said controller to determine said end of said treatment when said patient activates an "off" button connected to said controller.
  • said apparatus further comprises a patient interface sensor and said program further causes said controller to determine said end of said treatment when said patient interface sensor detects that said patient has removed said patient interface for a predetermined period of time.
  • said program further causes said controller to determine said end of treatment when a substantial increase of flow of gases is detected exiting said gas supply means for a predetermined period of time.
  • said apparatus further comprises a patient interface sensor and said program further causes said controller to determine said end of treatment when said patient interface sensor senses that said patient's breathing through said patient interface has ceased for a predetermined period of time.
  • a breathing assistance apparatus and method of controlling a breathing assistance apparatus is detailed below.
  • the breathing assistance apparatus is controlled such that it has a drying cycle to enable drying of the tubing that supplies gases to a user and prevent the harbouring of pathogens within the tube.
  • the drying cycle is preferably operated automatically by internal controllers in the apparatus. However, it may be manually activated by pressing a button on the apparatus.
  • the drying cycle is preferably activated at the end of a patient's treatment session.
  • the breathing assistance apparatus of the present invention is intended to typically deliver body temperature saturated gases (37°C and 44mg/L) over a range of flows that could provide up to a patient's inspiratory flow requirements (that is, peak inspiratory flow) plus any bias flow requirement.
  • the breathing assistance apparatus operates as a flow controlled device, so it adjusts the flow of gases to the level set by the patient or user, such as a care giver. Therefore, this apparatus can be used to deliver humidified gas for patients with bypassed airways, such as tracheotomies or nasal cannula or masks.
  • the breathing assistance apparatus of the present invention will generally have associated with it a gases supply means, such as ambient air, gases, such as oxygen from cylinders or other compressed gas supply, humidification means and a transport conduit from the humidification means to the patient, which is preferably heated to reduce condensation.
  • gases supply means such as ambient air
  • gases such as oxygen from cylinders or other compressed gas supply
  • humidification means and a transport conduit from the humidification means to the patient, which is preferably heated to reduce condensation.
  • a heating element is preferably provided within the transport conduit to help prevent condensation of the humidified gases within the conduit. Such condensation is due to the temperature of the walls of the conduit being lower than to the dew point of the gases inside the conduit, which is usually lower than the temperature of the humidified gases within the conduit.
  • the heating element effectively replaces the energy lost from the gases through conduction and convection during transit through the conduit and the patient interface.
  • the conduit heating element ensures the gases delivered are at an optimal temperature and humidity for patient treatment and to minimise condensation within the transport conduit and the patient interface.
  • the present invention provides a breathing assistance apparatus where the flow of gases passes in sequence through a gases supply means or flow driver (such as, a blower, fan or compressor), humidification chamber, heated delivery circuit and patient interface, such as that shown in Figure 1 .
  • a gases supply means or flow driver such as, a blower, fan or compressor
  • humidification chamber such as, a humidification chamber
  • heated delivery circuit such as that shown in Figure 1 .
  • a patient 1 is receiving humidified and pressurised gases through a nasal cannula 20 connected to a humidified gases transportation pathway or inspiratory conduit 3 that in turn is connected to a humidifier 8 (including humidification chamber 5) that is supplied with gases from a blower 15 or other appropriate gases supply means.
  • the inspiratory conduit 3 is connected to the outlet 4 of a humidification chamber 5 which contains a volume of water 6.
  • Inspiratory conduit 3 contains heating means or heater wires 11 that heat the walls of the conduit to reduce condensation of humidified gases within the conduit and the patient interface (e.g. nasal cannula 20).
  • the humidification chamber 5 is preferably formed from a plastics material and may have a highly heat conductive base (for example an aluminium base) which is in direct contact with a heater plate 7 of humidifier 8.
  • the humidifier 8 is provided with control means or electronic controller 9 which may comprise a microprocessor based controller executing computer software commands stored in associated memory.
  • Gases flowing through the inspiratory conduit 3 are passed to the patient by way of a patient interface 20.
  • the patient interface used with the apparatus of the present invention may be a full-face mask, nasal mask, nasal cannula, oral mouthpiece or tracheostomy connection.
  • Controller 9 receives input from sources such as user input means or dial 10 through which a user of the device may, for example, set a predetermined required value (preset value) of humidity or temperature of the gases supplied to patient 1.
  • a user of the device may, for example, set a predetermined required value (preset value) of humidity or temperature of the gases supplied to patient 1.
  • controller 9 determines when (or to what level) to energise heater plate 7 to heat the water 6 within humidification chamber 5.
  • the blower 15 may be provided with a variable speed pump or fan 2 which draws air or other gases through the blower inlet 17.
  • the speed of variable speed pump or fan 2 may be controlled by a further control means or electronic controller 18 (or alternatively the function of this controller 18 could be carried out by the other controller 9) in response to inputs from controller 9 and a user set predetermined required value (preset value) of pressure or fan speed via dial 19.
  • the breathing assistance apparatus of the present invention the gases supply or blower is combined in one housing with the humidifier and humidification chamber.
  • the humidification chamber 35 extends out from the housing 30 and is capable in use of being removed and replaced by the patient or other user.
  • the inlet port (not shown) to the humidification chamber 35 is internal within the housing 30.
  • the inlet 31 to the housing 30 where gases are drawn from the ambient air outside the housing 30 is located at the end of the housing 30, but in actuality may be located at any appropriate point in the housing 30.
  • the gases exit from the humidification chamber 35 at the outlet 33 and water within the chamber 35 is heated by a heater plate 36, similar to that described above. It must be appreciated that the embodiment described above in relation to the housing and Figure 2 merely illustrates one form of the housing of the combined gases supply and humidifier of the present invention.
  • a nasal cannula 20 is used as the patient interface.
  • the initial connection of a patient 1 to a blower and humidifier is an obstacle to patient compliance and negates a patient's comfort and tolerance due to the high pressure supply of gases through the cannula. Therefore, it would be advantageous if the gases flow was slowly increased to the patient, allowing their body time to adjust to the temperature, sensation of flow, and pressure in their nasopharynx. This slow increase in flow may be over a considerable time, such as 30 minutes, allowing the patient to slowly adjust to the therapy instead of feeling overwhelmed with the sudden delivery to the nasal passage, of up to 40L/min of saturated gases.
  • the blower 15 may be controlled by a controller (18 or 9) such that on start-up or commencement of therapy by the patient 1 the flow rate of gases exiting the blower 15 is initially supplied as a low flow.
  • the aim is to deliver optimal gas to the patient.
  • a set value most preferably 37°C.
  • the temperature of the gases at the chamber outlet are measured by a sensor this is the temperature that is to be controlled to the set temperature value.
  • the patient is supplied with an optimal temperature of gases as soon as possible. This is achieved by; turning on the heater plate 7 to full heating output, providing a low flow of gases through the humidification chamber 5 and controlling the wall temperature of the heated conduit 3 to avoid condensation.
  • the gases temperature in the humidification chamber 5 reaches the set temperature the gases flow is increased to the predetermined therapy flow as fast as possible, while maintaining the gases temperature in the chamber at the set temperature.
  • the increasing of the gases flow is performed by controlling (increasing) the speed of the fan 21 in the blower 15.
  • the flow is increased to the target or predetermined flow for the therapy.
  • a signal is given by the controller that the patient can now wear the interface.
  • gases flow is increased from the initial low flow (flow initial ) to a flow that is optimal (flow opt ) for the therapy being provided. It is preferred that the maximum or optimum flow level (flow opt ) is selectable by the user or care provider by way of dial 19.
  • the controller 18 or 9 would control the flow rate, by controlling the fan 21 speed so that the gases flow is initially at a low flow rate of, for example, 5 L/min.
  • the gases flow could be switched on for, for example, 1 to 15 seconds, at a low flow of, for example, 5 L/min to allow the temperature and humidity readings to be taken. Then the gases flow would be switched off for a period of time, for example, 5 to 60 seconds, to allow the humidity in the chamber to rise quicker.
  • the flow of the gases is ramped up over a predetermined time, for example, 30 minutes, to an optimum flow level (flow opt ) of between 15 to 40L/min, as selected by the patient.
  • the above sequence of events enables the humidity in the breathing circuit to reach the desired level as quickly as possible while minimising condensation and/or thermal overshoot.
  • the breathing assistance apparatus of the present invention provides a mode or cycle of drying out the conduit 3 and potentially the interface 20. This is carried out by providing a turn off process that facilitates the drying of the conduit 3 and the patient interface 20.
  • a drying mode is critical in minimising the risk of pathogen transport via the conduit 3 and interface 20 to the patient 1.
  • a drying mode also ensures there will be no condensation left in the conduit or patient interface after a treatment session and in a next treatment session. Condensation can cause gurgling noises and surges in airflow at the beginning of the next humidification session making treatment uncomfortable for the patient.
  • the aim of the drying mode is to ensure the humidity of the gases in the chamber and conduit are at or below the ambient levels the apparatus is operating in. This is achieved by cooling the water in the humidification chamber 5, while continuing to heat the conduit 3 and the interface 20 to a temperature that exceeds the chamber outlet gases temperature. This is continued until the humidifier water temperature and temperature of the gases at the chamber outlet reach or approximate room temperature. As the thermal mass of the water in the chamber 5 exceeds the thermal mass of the plastic walls of the conduit 3, condensation may occur if the humidifier 8 and the blower fan 21 are turned off at the same time. To ensure this does not occur, at the end of treatment it is preferred that the heater plate 7 is turned off but power is maintained to a heater wire 11 in the conduit 3.
  • the humidification means, humidifier 8, is controlled by the control means (controller 9 or 18) at the completion of a patient's treatment. Therefore, when the patient selects "off", a button on the apparatus, or the controller detects the end of a therapy session, effectively only the heater plate 7 is powered down by the controller (9 or 18) and the humidification apparatus is placed in a drying mode. During the drying mode, it is preferred that power is maintained to the heater wire 11 and the gases supply means or blower 15.
  • the gases flow through the humidifier 8 and conduit 3 is a flow, such as 20 litres per minute for a period of time, for example 15 minutes, which will ensure the conduit has dried inside.
  • the gases flow may be a fixed gases flow or pulses of gases flow.
  • a temperature sensor 13 is preferably provided at the end of the conduit, nearest the patient. This end of conduit temperature sensor 13 is connected to the controller 9, 18. The end of conduit sensor 13 may be used to optimise drying of the conduit 3 by ensuring the gases at the end of the breathing circuit are at the maximum safe operating temperature, so that the temperature of the gases does not obtain a level that might burn a patient or user.
  • the conduit may not include a heater wire.
  • the controller would merely control the blower 15, such that gases and not heat from the heater wire within the conduit alone would dry the conduit.
  • the point in time that the drying mode is deactivated may be determined by a number of methods.
  • the first of which is to measure the temperature of gases at the chamber outlet 4.
  • ambient temperature which is preferably measured by an additional temperature sensor, for example, located at the blower 15 but connected to one of the controllers 9, 18
  • the blower 15 and heater wire 11 are powered off by the controller 9, 18. In this way gases flow through the humidification chamber 6 and as the heater plate 7 cools the humidity of the gases flowing through the conduit 3 reduces and the conduit 3 becomes drier.
  • a second method for determining when the drying mode is to be deactivated by the controller 9, 18 is to turn off the power to the humidification chamber 5 and maintain a gases flow through the conduit 3 at a fixed speed or pulses and maintain power in the heater wire 11 to evaporate any condensate off the walls of the conduit 3. After a predetermined time, preferably in excess of one minute, the heater wire 11 and flow source (blower) would be switched off.
  • Yet another method of controlling the drying of the conduit is to switch the gases supply (blower) off and switch off the power to the heater plate power.
  • the controller 9, 18 would then compare the heater plate 7 temperature with an ambient temperature that is measured either inside or outside the humidifier or blower (as previously described). When this temperature difference or comparison is within a predetermined limit, which typically approximates zero, a flow of gases is caused to flow in the same manner as described above.
  • the drying mode is activated by the patient selecting or pressing an "off" button.
  • An alternative method of activating the drying mode is to detect the patient 1 removing the interface 20. This may be, for example, by detecting an increase in the flow from the blower due to decreased resistance at the patient interface at the end of a humidification session. After a predetermined time period has elapsed, which is long enough to ensure the patient does not put the interface back on, the drying mode is commenced.
  • the time at which the patient stops breathing into the patient interface 20 may be detected. This may be detected by monitoring for a breathing pattern, for example using a flow sensor on the patient interface or in the blower. Once no breathing is found and after waiting a predetermined time period the drying mode is commenced.
  • a user or patient In order for the apparatus to be fully powered down a user or patient must disconnect the apparatus from the electrical power supply or for example, hold a switch or power button down on the humidifier or blower for a period of time, for example, 5 seconds.

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Claims (15)

  1. Appareil d'assistance respiratoire conçu pour administrer des gaz humidifiés à un niveau souhaité d'humidité, de débit et de température pour le traitement d'un patient (1), l'appareil comprenant :
    a) un moyen de fourniture de gaz (15) fournissant un débit de gaz ;
    b) un humidificateur (8) comportant une chambre (5) conçue pour recevoir un volume d'eau (6), et un élément chauffant de chambre (7) permettant de chauffer ladite eau dans ladite chambre, ladite chambre comprenant une entrée (16) et une sortie (4) ;
    c) un moyen faisant passage de transport (3) permettant de transporter lesdits gaz humidifiés dudit humidificateur (8) audit patient (1) ; et
    l'appareil étant caractérisé en ce qu'il comprend en outre :
    d) un contrôleur (9, 18) dans lequel sont stockées des instructions permettant de réaliser les étapes suivantes à la fin dudit traitement dudit patient :
    i) mettre hors tension ledit élément chauffant de chambre (7) ;
    ii) régler ledit débit de gaz par ledit moyen de fourniture de gaz (15) ; et
    dans lequel ledit moyen faisant passage de transport (3) comprend un élément chauffant de passage (11), ledit débit de gaz étant réglé à un débit prédéterminé pendant une durée prédéterminée, ledit élément chauffant de passage (11) permettant de transmettre de la chaleur audit débit de gaz pendant la durée prédéterminée, et ledit moyen de fourniture de gaz étant mis hors tension après ladite durée prédéterminée.
  2. Appareil d'assistance respiratoire selon la revendication 1, ledit appareil comprenant en outre :
    a) un capteur de température de sortie (12) mesurant la température desdits gaz au niveau de ladite sortie (4) de ladite chambre ;
    b) un capteur de température distale (13) mesurant la température desdits gaz à l'extrémité distale du moyen faisant passage de transport (3) ;
    c) un capteur de température ambiante mesurant la température d'air ambiant, et ledit contrôleur (9, 18) comprenant des instructions stockées permettant de :
    i) contrôler ledit élément chauffant de passage (11) pendant ladite durée prédéterminée de sorte que la température desdits gaz à l'extrémité distale dudit moyen faisant passage de transport (3), telle que détectée par ledit capteur de température distale, ne dépasse pas un niveau de température sûr ; et
    ii) surveiller ledit capteur de température de sortie (12) et ledit capteur de température ambiante, comparer ladite température de gaz de sortie et ladite température d'air ambiant, et quand ces températures sont sensiblement égales, terminer ladite durée prédéterminée et mettre hors tension ledit moyen de fourniture de gaz (15) et ledit élément chauffant de passage (11).
  3. Appareil d'assistance respiratoire selon la revendication 1, ledit appareil comprenant en outre :
    a) un capteur de température distale (13) mesurant la température desdits gaz à l'extrémité distale du moyen faisant passage de transport (3) ;
    b) un capteur de température ambiante mesurant la température d'air ambiant, un capteur de température d'élément chauffant de chambre mesurant ladite température d'élément chauffant de chambre, et ledit contrôleur (9, 18) comprenant des instructions stockées permettant de :
    i) contrôler ledit élément chauffant de passage (11) pendant ladite durée prédéterminée de sorte que la température desdits gaz à l'extrémité distale dudit moyen faisant passage de transport (3), telle que détectée par ledit capteur de température distale, ne dépasse pas un niveau de température sûr ; et
    ii) surveiller ledit capteur de température d'élément chauffant de chambre et ledit capteur de température d'air ambiant, comparer ladite température d'élément chauffant de chambre et ladite température d'air ambiant, et quand ces températures sont sensiblement égales, terminer ladite durée prédéterminée et mettre hors tension ledit moyen de fourniture de gaz (15) et ledit élément chauffant de passage (3).
  4. Appareil d'assistance respiratoire selon l'une quelconque des
    revendications 1 à 3, dans lequel ledit moyen faisant passage de transport (3) est un tube de plastique extrudé, et ledit élément chauffant de passage (11) consiste en au moins deux fils conducteurs intégrés dans la paroi, à travers la paroi ou autour de la paroi dudit tube.
  5. Appareil d'assistance respiratoire selon l'une quelconque des
    revendications 1 à 4, dans lequel ledit contrôleur (9, 18) comprend des instructions stockées pour déterminer ladite fin dudit traitement quand ledit patient active un bouton « arrêt » connecté audit contrôleur (9, 18).
  6. Appareil d'assistance respiratoire selon l'une quelconque des
    revendications 1 à 4, ledit appareil comprenant en outre un capteur d'interface de patient, et dans lequel ledit contrôleur (9, 18) comprend des instructions stockées pour déterminer ladite fin dudit traitement quand ledit capteur d'interface de patient détecte que ledit patient (1) a retiré ladite interface de patient (20) pendant une période de temps prédéterminée.
  7. Appareil d'assistance respiratoire selon l'une quelconque des
    revendications 1 à 4, dans lequel ledit contrôleur (9,18) comprend des instructions stockées pour déterminer ladite fin du traitement quand une augmentation significative du débit de gaz est détectée en sortie dudit moyen de fourniture de gaz (15) pendant une période de temps prédéterminée.
  8. Appareil d'assistance respiratoire selon l'une quelconque des
    revendications 1 à 4, ledit appareil comprenant en outre un capteur d'interface de patient, et dans lequel ledit contrôleur (9, 18) comprend des instructions stockées pour déterminer ladite fin du traitement quand ledit capteur d'interface de patient détecte que la respiration dudit patient par ladite interface de patient (20) a cessé pendant une période de temps prédéterminée.
  9. Procédé de contrôle d'un appareil d'assistance respiratoire, dans lequel ledit appareil est conçu pour administrer des gaz humidifiés à un niveau souhaité d'humidité, de débit et de température pour le traitement d'un patient (1), ledit appareil comprenant un moyen de fourniture de gaz (15) fournissant un débit de gaz, un humidificateur (8) comportant une chambre (5) conçue pour recevoir un volume d'eau, et un élément chauffant de chambre (7) permettant de chauffer ladite eau dans ladite chambre (5), un moyen faisant passage de transport (3) permettant de transporter lesdits gaz humidifiés dudit humidificateur (8) audit patient (1), ledit moyen faisant passage de transport (3) comprend un élément chauffant de passage (11), l'appareil étant caractérisé en ce qu'il comprend en outre un contrôleur (9, 18) stockant un programme amenant le contrôleur (9, 18) à la fin dudit traitement dudit patient à réaliser le procédé comprenant les étapes suivantes :
    a) mettre hors tension ledit élément chauffant de chambre (7) ;
    b) régler ledit débit de gaz dudit moyen de fourniture de gaz (15) à un débit prédéterminé pendant une durée prédéterminée, ledit élément chauffant de passage (11) permettant de transmettre de la chaleur audit débit de gaz pendant la durée prédéterminée ; et
    c) après ladite durée prédéterminée, mettre hors tension ledit moyen de fourniture de gaz (15).
  10. Procédé de contrôle d'un appareil d'assistance respiratoire selon la revendication 9, dans lequel ledit appareil comprend un capteur de température de sortie (12) mesurant la température desdits gaz au niveau de ladite sortie (4) de ladite chambre (5), un capteur de température distale (13) mesurant la température desdits gaz à l'extrémité distale du moyen faisant passage de transport (3), un capteur de température ambiante mesurant la température d'air ambiant, et ledit programme amenant en outre ledit contrôleur (9, 18) à :
    a) contrôler ledit élément chauffant de passage (11) pendant ladite durée prédéterminée de sorte que la température desdits gaz à l'extrémité distale dudit moyen faisant passage de transport (3), telle que détectée par ledit capteur de température distale, ne dépasse pas un niveau de température sûr ; et
    b) surveiller ledit capteur de température de gaz de sortie (12) et ledit capteur de température d'air ambiant, comparer ladite température de gaz de sortie et ladite température d'air ambiant, et quand ces températures sont sensiblement égales, terminer ladite durée prédéterminée et mettre hors tension ledit moyen de fourniture de gaz (15) et ledit élément chauffant de passage (11).
  11. Procédé de contrôle d'un appareil d'assistance respiratoire selon la revendication 9, dans lequel ledit appareil comprend en outre un capteur de température distale (13) mesurant la température desdits gaz à l'extrémité distale du moyen faisant passage de transport (3), un capteur de température ambiante mesurant la température d'air ambiant, un capteur de température d'élément chauffant de chambre mesurant ladite température d'élément chauffant de chambre, et ledit programme amenant en outre ledit contrôleur (9, 18) à :
    a) contrôler ledit élément chauffant de passage (11) pendant ladite durée prédéterminée de sorte que la température desdits gaz à l'extrémité distale dudit moyen faisant passage de transport (3), telle que détectée par ledit capteur de température distale, ne dépasse pas un niveau de température sûr ; et
    b) surveiller ledit capteur de température d'élément chauffant de chambre et ledit capteur de température d'air ambiant, comparer ladite température d'élément chauffant de chambre et ladite température d'air ambiant, et quand ces températures sont sensiblement égales, terminer ladite durée prédéterminée et mettre hors tension ledit moyen de fourniture de gaz (15) et ledit élément chauffant de passage (11).
  12. Procédé de contrôle d'un appareil d'assistance respiratoire selon l'une quelconque des revendications 9 à 11, dans lequel ledit programme amène ledit contrôleur (9, 18) à déterminer ladite fin dudit traitement quand ledit patient (1) active un bouton « arrêt » connecté audit contrôleur (9, 18).
  13. Procédé de contrôle d'un appareil d'assistance respiratoire selon l'une quelconque des revendications 9 à 11, dans lequel ledit appareil comprend en outre un capteur d'interface de patient, et dans lequel ledit programme amène en outre ledit contrôleur à déterminer ladite fin dudit traitement quand ledit capteur d'interface de patient détecte que ledit patient (1) a retiré ladite interface de patient (20) pendant une période de temps prédéterminée.
  14. Procédé de contrôle d'un appareil d'assistance respiratoire selon l'une quelconque des revendications 9 à 11, dans lequel ledit programme amène en outre ledit contrôleur à déterminer ladite fin du traitement quand une augmentation significative du débit de gaz est détectée en sortie dudit moyen de fourniture de gaz (15) pendant une période de temps prédéterminée.
  15. Procédé de contrôle d'un appareil d'assistance respiratoire selon l'une quelconque des revendications 9 à 11, dans lequel ledit appareil comprend en outre un capteur d'interface de patient, et dans lequel ledit programme amène en outre ledit contrôleur (9, 18) à déterminer ladite fin du traitement quand ledit capteur d'interface de patient détecte que la respiration dudit patient par ladite interface de patient (20) a cessé pendant une période de temps prédéterminée.
EP06747709.1A 2005-05-26 2006-05-26 Appareil d'assistance respiratoire Active EP1883440B1 (fr)

Applications Claiming Priority (2)

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NZ54040205 2005-05-26
PCT/NZ2006/000132 WO2006126900A1 (fr) 2005-05-26 2006-05-26 Appareil d'assistance respiratoire

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EP1883440A1 EP1883440A1 (fr) 2008-02-06
EP1883440A4 EP1883440A4 (fr) 2011-03-02
EP1883440B1 true EP1883440B1 (fr) 2017-07-12

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CA2609738C (fr) 2014-01-07
US12194245B2 (en) 2025-01-14
US20080190427A1 (en) 2008-08-14
AU2006250091A1 (en) 2006-11-30
CN101252966A (zh) 2008-08-27
US11679228B2 (en) 2023-06-20
US9168350B2 (en) 2015-10-27
EP1883440A1 (fr) 2008-02-06
WO2006126900A1 (fr) 2006-11-30
CA2609738A1 (fr) 2006-11-30
JP5058982B2 (ja) 2012-10-24
DK1883440T3 (en) 2017-10-23
CN101252966B (zh) 2012-07-18
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US20240108847A1 (en) 2024-04-04
US20150165157A1 (en) 2015-06-18
US8893715B2 (en) 2014-11-25
EP1883440A4 (fr) 2011-03-02
US20160106948A1 (en) 2016-04-21
US9839759B2 (en) 2017-12-12
US20180161536A1 (en) 2018-06-14
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JP2008541830A (ja) 2008-11-27
US20220339394A1 (en) 2022-10-27

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